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Finals Revision > Oncology/Palliative Care/MFE > Flashcards

Oncology/Palliative Care/MFE Flashcards

1
Q

Treatment of N&V with chemo?

1st, 2nd, breakthrough, anticipatory

A

1st - 5-HT3 antagonist - Ondansetron
(very effective if combined with dexamethasone)

2nd - NK1 antagonist - Apreptide

Breakthrough - Metoclopramide or Ondansetron

Anticipatory - Lorazepam

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2
Q

Management of spinal cord compression?

A

16mg Dex, followed by 8mg BD

Refer to neurosurgeons - consider surgery esp if single vertebral involvement, or radio-resistant cancer (renal, sarcoma) or unknown primary (get biopsy)

Radiotherapy mainstay of treatment, chemo may be used

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3
Q

How does malignant spinal cord compression normally present?

A

Radicular pain

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4
Q

Initial Ix for SVCO?

A

CXR - is there a mass?

Venogram - is there a clot?

CT chest

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5
Q

Treatment options for SVCO if clot?

A

Thrombolyse - alteplase

Anticoagulate - LMWH or warfarin

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6
Q

Treatment if SVCO from extrinsic compression?

A
  1. Dex - always given, but probably doesn’t help
  2. endovascular stenting treatment of choice

Radiotherapy and chemo can be used depending on cause (SCLC, lymphoma = chemo)

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7
Q

With malignant hypercalcaemia, after corrected Ca, what is the most useful test?
What other tests?

A

Most: U&E (dehydration)

Phosphate - low in hyperparathyroid (if PTHrp)

Myeloma screen - if unknown malignancy

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8
Q

Bone mets - what is high?

A

Ca and ALP

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9
Q

Hypercalcaemia - immediate management?

A

IV fluids - several litres

60-90mg Pamidronate over 2 hours (can cause renal failure so make sure rehydrated first)
Takes several days to a week to work

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10
Q

Signs of malignant pericardial tamponade?

A

Raised JVP
Pulsus paradoxus (BP drops by 10mmHg on inspiration)
Muffled heart sounds/Pericardial rub

Poor CO - tachycardia with low BP and poor peripheral perfusion

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11
Q

Ix for pericardial effusion?

Rx?

A

CXR - enlarged heart size

ECG - low amplitude

Echo - rim of pericardial fluid - take cytology

Rx: pericardiocentesis
Potential creation of a pericardial window

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12
Q

Define neutropenic sepsis?

A

Temp >37.5 with:
- neutrophils <0.5

Management:

  • Take bloods
  • blood cultures
  • Tazocin (or aztreonam + teicoplanin)
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13
Q

Tumour lysis syndrome:

  • cause?
  • what electrolyte disturbance?
  • presentation?
  • management?
A

Rapid destruction of malignant cells due to chemotherapy, causing

  • hyperkalaemia
  • hyperuricaemia
  • hyperphosphataemia
  • hypOcalcaemia

Commonly seen in haem malignancies such as Burkitt’s lymphoma, and other extremely chemo-sensitive malignancies

Presentation:

  • AKI
  • seizure
  • arrhythmias
  • muscle cramps, cognitive changes

Management:

  • as per each electrolyte disturbance
  • hydration and allopurinol
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14
Q

What is used for secretions in palliative care?

A

Hyoscine or Glycopyrronium

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15
Q

What is the preferred opioid for pain in syringe driver?

A

diamorphine

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16
Q

Codeine to morphine?

A

divide by 10

17
Q

Morphine to sc morphine?

A

divide by 2

18
Q

Morphine to diamorphine?

A

divide by 2

19
Q

oral morphine to oral oxycodone?

A

divide by 1.5-2

20
Q

tramadol to morphine?

A

divide by 10

21
Q

When upping dose of opioids, how much should it be raised by?

A

30-50%

22
Q

In addition to opioids, what else can be used to treat bone pain?

A

Bisphosphonates, radiotherapy or denusomab

23
Q

What is the preferred opioid in mild-mod renal impairment?

A

Oxycodone

24
Q

What is the preferred opioid in severe renal impairment?

A

Alfentanyl or buprenorphine

25
Q

What to prescribe alongside opioids?

A

Laxative

26
Q

1st line for intractable hiccups in palliative care?

A

Chlorpromazine

27
Q

1st and 2nd line for agitation in palliative care?

In terminal stage in syringe driver?

A

1st - haloperidol
2nd - chlorpromazine, levomepromazine

Terminal - midazolam

28
Q

Treatment of nausea due to gastroparesis?

A

Metoclopramide or domperidone

not in bowel obstruction or just after GI surgery

29
Q

Treatment of medically induced nausea?

A

Ondansetron

30
Q

Treatment of visceral nausea?

A

Diffuse pain hard to pinpoint

Cyclizine

31
Q

Treatment of nausea due to raised ICP?

A

Cyclizine and Dexamethasone

32
Q

Treatment of vestibular nausea?

A

Cyclizine

33
Q

Treatment of anticipatory nausea?

A

Lorazepam

34
Q

Management of neutropaenic sepsis?

A

Give Tazocin immediately, do not await results
If still feverish after 48 hours consider switching to meropenem +/- vancomycin
If still feverish after 4-6 days consider Ix for fungal infections

35
Q

What is given in syringe driver if still getting bowel colic (e.g. in bowel cancer) and already receiving morphine?

A

Hyoscine/Glycopyrronium

36
Q

What can be given before chemo if there is a risk of tumour lysis syndrome?

A

Allopurinol or Rasburicase

Finals Revision (29 decks)

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